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Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians

Published online by Cambridge University Press:  01 April 2015

Cheryl Hunchak ,
David Tannenbaum ,
Michael Roberts ,
Thrushar Shah ,
Predrag Tisma ,
Howard Ovens  and
Bjug Borgundvaag
Cheryl Hunchak*
Affiliation:
Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, ON
David Tannenbaum
Affiliation:
The Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, Toronto, ON
Michael Roberts
Affiliation:
The Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, Toronto, ON
Thrushar Shah
Affiliation:
Information Technology, Mount Sinai Hospital, Toronto, ON
Predrag Tisma
Affiliation:
Information Technology, Mount Sinai Hospital, Toronto, ON
Howard Ovens
Affiliation:
Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, ON
Bjug Borgundvaag
Affiliation:
Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, ON
*
Correspondence to: Dr. Cheryl Hunchak, Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex, 60 Murray Street, Toronto, ON M5G 1X5; chunchak@gmail.com.

Abstract

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Objective: Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information.

Methods: Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys.

Results: Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ‘‘often’’ or ‘‘always’’ aware of patient ED visits, used the portal ‘‘always’’ or ‘‘regularly’’ to access patients’ health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care.

Conclusion: Introduction of a web-based ED visit communication tool improved ED–family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.

Résumé

Objectif: La communication avec les médecins de famille après le renvoi des patients du service des urgences (SU) laisse souvent à désirer, et ce manque de relation a une incidence défavorable sur les soins. Nous avons conçu et mis à l’essai un outil de communication en ligne, qui informe, par voie électronique, les médecins de famille de la visite d’un de leurs patients au SU et qui leur donne accès aux résultats d’examens de laboratoire ou de diagnostic.

Méthode: Neuf médecins de famille (sur 10 invités) ayant un nombre élevé de malades dirigés ont participé à ce projet pilote mené dans un seul SU. Un examen des dossiers (30 patients pour chacun des médecins de famille) durant la phase préexpérimentale a permis de dé terminer le volume de base de transmission des dossiers sur papier. Les neuf médecins de famille ont conçu un portail de communication sur le Web et l’ont mis à l’essai pendant un an. Les participants ont fait part de leurs observations sur la convivialité dans des groupes de réflexion et dans des enquêtes écrites.

Résultats: Une revue de 270 dossiers de patient durant la phase préexpérimentale a révélé un taux initial de dossiers rédigés à la main de 13% et un taux de communication de renseignements de 44% entre le SU et les cabinets des médecins de famille après le congé. Durant la phase expérimentale, les médecins de famille participants ont totalisé 880 visites de patients. Sept médecins de famille et deux autres ont consulté respectivement 74% et 12% des dossiers en ligne qui faisaient suite à des visites, soit un taux global de 60.7% des visites, ce qui représente une augmentation absolue générale de 17% de la communication de renseignements relatifs à des visites au SU. Dans l’enquête menée durant la phase postexpérimentale, 100%desmédecins de famille ont indiqué qu’ils étaient «souvent» ou «toujours» au courant des visites de leurs patients au SU, qu’ils utilisaient «toujours» ou «périodiquement» le portail pour consulter les dossiers de leurs patients en ligne et qu’ils avaient l’impression que le portail Web avait contribué à l’amélioration de la continuité réelle ou perc¸ue des soins aux patients.

Conclusions: La mise en place d’un outil de communication sur le Web, concernant les consultations au SU, ont amélioré les échanges entre les médecins de famille et le service en question. Toutefois, l’incidence de cet outil sur l’amélioration de la continuité des soins, la rapidité du suivi, et la réduction des demandes en double d’examens et de consultations en spécialité reste à approfondir.

Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 2 , March 2015 , pp. 123 - 130
Copyright
Copyright © Canadian Association of Emergency Physicians 2015 

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